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Panel Endorses Active Monitoring and Delay of Treatment for Low-Risk Prostate Cancer
Many men with localized, low-risk prostate cancer should be closely monitored, permitting treatment to be delayed until warranted by disease progression, according to an independent panel convened for a State-of-the-Science Conference by the National Institutes of Health (NIH).
The conference was held in December 2011 to review the current medical evidence regarding the role of active surveillance and other monitoring strategies for low-grade, localized prostate cancer detected by prostate-specific antigen (PSA) screening. Based on this evidence and the input of conference attendees, the panel prepared a final statement.
“Prostate cancer affects some 30 to 40% of men over the age of 50. Some of these men will benefit from immediate treatment; others will benefit from close monitoring. Low-risk, non-life- threatening disease has a very favorable prognosis, and we believe delaying treatment is a safe option for many men,” said Dr. Patricia A. Ganz, conference panel chairperson and director of the Division of Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.
In 2011, approximately 240,000 men were newly diagnosed with prostate cancer. More than half of these diagnosed cancers are localized (confined to the prostate) and unlikely to become life-threatening. However, approximately 90% of patients receive immediate treatment, such as surgery or radiation therapy. For many of these patients, treatment has substantial short- and long-term side effects without clear benefits. Identifying appropriate management strategies for different subgroups of patients is critical to improving survival and reducing the burden of adverse effects.
The panel identified emerging consensus in the medical community on a definition for low-risk prostate cancer: a PSA level less than 10 ng/mL and a Gleason score of 6 or less. Using this definition, the panel estimated that more than 100,000 men diagnosed with prostate cancer each year would be candidates for active surveillance (proactive patient follow-up in which blood samples, digital rectal exams, and repeat prostate biopsies are conducted on a regular schedule) rather than immediate treatment.
Importantly, however, the panel found that protocols to manage active monitoring still vary widely, hampering the evaluation and comparison of research findings. They recommended standardizing definitions and conducting additional studies to clarify which monitoring strategies are most likely to optimize patient outcomes.
Additional materials are available on the conference homepage.
The panel’s statement is an independent report and does not represent the policy of the NIH or the Federal Government. The conference, which is available via an archived webcast, was sponsored by the NIH’s Office of Disease Prevention, the National Cancer Institute, and the Centers for Disease Control and Prevention, along with other NIH and U.S. Department of Health and Human Services components. This conference was conducted under the NIH Consensus Development Program, which convenes conferences to assess the available scientific evidence and develop objective statements on controversial medical issues.